Customer left out crucial life insurance information

Categories:
Insurance policies,
Summary:
Leslie took out life insurance in late 2017. She told the bank she had hypertension, which had been diagnosed 10 years earlier, although she wasn’t taking any medication. This was indeed correct. However, she gave incorrect information when asked about the most recent blood pressure reading. Leslie provided a reading from mid-2017, but according to her medical notes there was a more recent and higher reading in September 2017. When asked about any visits to the doctor and any repeat medications over the past five years, Leslie did not disclose that she had visited her doctor and been prescribed medication for her hypertension.
Published:
March 2021

Leslie died in late 2019. Her husband Joseph claimed on her life insurance, but the bank declined his claim, saying Leslie had not disclosed the extent of her hypertension or her failure to take her medication. Joseph didn’t accept the bank’s position because it hadn’t asked Leslie about the extent of her hypertension or whether she was taking the medication prescribed for her. She had correctly answered the questions about when it was diagnosed and whether she was currently taking medication.

Our investigation

We considered the bank had done a poor job explaining why it had rejected the claim. The wording of its questions had limited the information it sought, and Joseph was right in arguing the bank had not asked her the questions to which it wanted answers. Despite this, it was obvious Leslie had wrongly answered the question about her most recent blood test. The bank was legally entitled to cancel Leslie’s policy and decline Joseph’s claim if the information was substantially incorrect and would have resulted in the bank offering different terms if it had known the full picture.

We considered the reading Leslie gave was very different to the one her most recent medical records showed. Also, the bank provided a statement from another underwriter that it would not have offered cover had it known about the most recent blood pressure reading.

Outcome

We explained the above to Joseph and he withdrew his complaint.

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